HIV/AIDS and the Aging Population: What's Going On?

Kellee Terrell: What do you think clinicians can do better in treating seniors with HIV?

Frances Meléndez: Listen: I think that's what they can do better. And be up to date on the research. But to listen to the needs of the clients, which I think that, you know, it's not imposing your belief system, but to hear what they have to say. And they really are the experts in their life, and in being HIV positive.

James Masten: Of course, I was just thinking how doctors now have 15 minutes to see a new patient. And it's what's expected of them. I guess I have some empathy for them, as well.

One of the things that I wanted to make sure that people are aware of is that the American Academy of HIV Medicine recently came out with recommended treatment strategies for people living with HIV over age 50. And so there are guidelines out there, and there are collected information about it. We're beginning to learn more and so people do have; there is access to information for clinicians.

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Sean Cahill: I think the clinicians can better educate themselves about health disparities affecting LGBT people, and how those intersect with racial disparities. Particularly with this epidemic, we see that black gay and bisexual men, and transgender women, and Latinos, to a lesser extent, are disproportionately affected by the epidemic. So the intersection of sexual orientation and racial disparities is really critical.

And I understand that they're under huge time constraints, increasingly, like James just said, but they really should be asking their patients about their sexual orientation, as well as behavior. And they should do it on a periodic basis. They shouldn't just do it at an initial visit. Because somebody might become more comfortable with the provider, and over time be willing to disclose something that they're not willing to disclose right off the bat.

Also, people's identity changes over the course of their lifetime, whether it's their sexual orientation identity or their gender identity.

And then the last thing is, we really want to make sure that providers are treating people based on the standard of care, and not based on cost concerns. A key goal of the Affordable Care Act is to reduce costs and improve the efficiency of medicine. But it's critical that people be provided care that's based on what the standard of care is for the disease and set by the profession, and not solely based on concerns about cost.

So that means that if you have an older patient who you think might have a potential heart condition, heart problems, that you refer that person to a cardiologist and consider other specialty care, in addition to providing primary care.

Kellee Terrell: What is your advice to older people living with HIV?

Frances Melendez: At least for me, the issue is to really help empower clients to be able to advocate for themselves. Like you said, it's 15 minutes. How do you go in prepared to have a 15-minute session, and maybe write down exactly what the issues are to help you remember what's important to you when you go see that doctor. And that, for me, is self-advocacy. It's first and foremost.

James Masten: I have this 10-step strategy toward optimal aging with HIV. But I think I can really reduce it down to one word, which is adapt. Living, aging, with HIV means managing a great deal of change, whether it's the changes of the course of the illness, changes in the community, changes to your support system and your family structure, and in your body.

Some of the coping strategies that you might have developed to deal with HIV might not be the best coping strategies to deal with HIV at this stage of your life, to deal with living with HIV. So it's a constant reevaluation, and reassessment of how I'm doing. How am I coping? And that's a lot of work. And who are my supports? And have I given up on something, some area of life, that might not be in my best interest to let this go? It's a challenge to remain adaptive and resilient.

Sean Cahill: What I would say in a phrase is, "Love yourself, take care of yourself."

So many people are working now, compared to, say 20 or 25 years ago. Many people with HIV are working full-time jobs. And, you know, it's hard. Living with HIV for decades is hard on your body. And I think people need to strike a balance in their lives, and keep things in perspective, and not allow work-related stress to become too great.

And really, to not settle for less than full respect from your family, your friends, your health care provider, I think is really key. So people should just love themselves, feel confident, and demand the best from the people they interact with, and the world.

James Masten: I would also like to add, that as a clinician, as a researcher, as a social scientist, that we want to advocate for the care of people that we want to help. And in some ways, sometimes, we do that by presenting the worst-case scenario, or how dire the picture is. And it's harder to point out that -- in my work I have also seen incredible strength and resilience. And the answer, you know: as Frances said, people have that in them already. They know what to do. And it's building on those strengths. And it is reforming, forming communities with people who are doing it, who are maybe better in one area, have some answers in how to deal with your doctor, whereas you've got strengths in other areas.

So I've often seen it's people who are doing very well adapting to aging with HIV, and who use all the strengths, all the lessons that they've learned in life to help manage, help them at this stage in their life. So I want to make sure that that comes through, as well.

Kellee Terrell: That's such a wonderful point James. Thank you. Sean and Fran, do you have any final thoughts?

Frances Meléndez: I just want to say thank you for saying that. Because I think that's one of the things I believe in too -- to look at the strengths that people bring to the table. Because it takes courage to live every day, having to take X amount of pills, for a multitude of issues that may be going on. And I think it is courageous to make the decision to live a healthy life, and to see what comes to the table as strengths, and build on that. So I appreciated that comment. Because that's huge -- to see the resiliency in the people we work with.

Sean Cahill: Right. And you know, as millions of Americans, are hitting age 65, and entering the senior care system; I think that people with HIV have a lot to teach the rest of the country.

Like you said, James, they have been advocating for themselves for, you know, for 30 years. They had to because the government wasn't responding at the outset and there was a lot of negative reaction, homophobia, and so on.

And so I think that people living with HIV and AIDS, as well as other activists working on the issue, have a lot to teach the rest of the country in terms of how to create a comprehensive system of care, that addresses not just the physical health needs, but the mental and spiritual health needs of people living with this chronic disease.

This transcript has been lightly edited for clarity.

Kellee Terrell is the former news editor for TheBody.com and TheBodyPRO.com.

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